Its funny how something we consider best practice will often be replaced by something we previously considered worst practice.

In a new study of 600 patients published in the Lancet, a below knee cast has been found to be more effective than a compression bandage in the management of sprained ankle.
In fact, a tubular compression bandage, combined with ice, elevation and advice to mobilize as soon as possible (which is pretty much current practice), was consistently found to be the worst treatment of all those examined.

Instead, a 10-day below-knee cast was associated with a speedier recovery in terms of ankle function, pain, symptoms and activity three months later.
John Heyworth, president of the College of Emergency Medicine, was quoted by the BBC as stating the study was:

“…practice-changing, high quality research”.
“What we do with these common problems, is we look for the best evidence and up until this paper, the evidence suggested that early mobility provided a better outcome and this provides some good evidence that immobilisation can provide greater benefits.”
Dr Martin Shalley, A&E consultant at Birmingham Heartlands Hospital, said they tried to avoid immobilising the ankle because of the risk of deep vein thrombosis.
“That has to be balanced and we can discuss the pros and cons with the patient and work out the best treatment programme for them.”

Unfortunately for the nursing/medical  staff, the correct application of a below knee plaster1 on all these sprained ankles will be considerably more time consuming than a simple tubi-grip bandage.

[photos credit: Daniel Paquet]

  1. this would include patient education, and a follow-up check to make sure the plaster was not too tight due to further swelling []

6 Responses to “cast now best treatment for sprained ankle.”

  1. i have just injured my ankle and have a below the knee walking cast, have injured my ankle 16 times in one year and this is the best treatment i have had so far, i can walk with not to much pain and my ankle is stable so i know it is not going to go over and re injure while its on, where as before with other or no treatment my ankle was unstable and caused reinjury very quickly thus delaying healing futher, will post later when cast comes off to see how it is.

  2. I find this interesting as I am just recovering from a severe sprain to my ankle. It was treated initially with a boot below the knee for about 10 days, progressing to an air splint and then a compression bandage. It is almost completely healed after 3 weeks. I stopped using the compression bandage a few days ago because it seemed to be more irritating than helpful. This is the fastest recovery I have had from such an injury. So, I don’t know about a cast and immobilization, but I think the boot was great. It provided needed support and allowed mobility.

  3. In my experience immediate mobilization of a Grade I and II lateral sprain affords the best results. Grade III sprain needs a little more detailed care. I really would be hard pressed to casting a sprained ankle. I mean you’d have to deal with the short term localized inflammation damage, joint immobilization, scar tissue adhesions, the list goes on. Whew.. that would be tough.
    Thanks for the info.

  4. Interesting, I would be more impressed if they had included no treatment in their choices instead of all interventions. In my department all Grade I and Grade II sprains are mobilised with no tubigrip, patients are advised ice and analgesia and are given exercises. A Grade III sprain may get nothing, a moonboot or if really required (rare) a below knee POP cast. I did an essay on ankle sprain for my ENP course and the evidence does not support the use of anything. See here http://www.bestbets.org/bets/bet.php?id=367 and also here http://www.bestbets.org/cgi-bin/bets.pl?record=00027

  5. …and of course the comment form is stripping HTML.

    http://joker.mirar.org/junk/hagar.gif this one.

    ;)

  6. I feel obliged to post this comic in response:

    ;)

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